Risedronate (risedronic acid)

Risedronate (brand name: Actonel®) is a drug treatment for osteoporosis.

Risedronate is a type of medication called a bisphosphonate. Bisphosphonates are the most common treatments for osteoporosis. You may be offered risedronate as a first treatment for osteoporosis. But it's more likely to be used as a second treatment, if you've been advised to change to a different drug for any reason.

Risedronate can help to make your bones stronger and reduce your risk of broken bones, including hip and spinal fractures.

How does risedronate work?

Bones are made up of living tissue. The inside of our bones is constantly being broken down and rebuilt by specialist bone cells. As long as this process is in balance, your bones should stay healthy and strong.

But if the process becomes out of balance, our bodies can start to break down more bone than we build. This can cause the bones to become weaker and more likely to break easily.

Risedronate works by slowing down the cells that break down bone. This helps to restore the balance and make your bones stronger.

You may still break a bone while taking risedronate. If this happens, it doesn't necessarily mean the drug isn't working. No medication can stop all fractures, but taking risedronate will make them much less likely.

Risedronate is not a pain-relieving medicine, so it won't reduce the pain caused by broken bones. But there are other treatments and ways to manage pain.

Risedronate may be suitable if you have osteoporosis, or if your risk of breaking a bone is high enough to need a drug treatment.

It is licensed for use in women who have been through the menopause, and for men. Doctors will occasionally offer risedronate to younger women.

People are usually offered a very similar tablet, called alendronate, to start with. But you may be offered risedronate instead, particularly if you have a sensitive stomach or food pipe. This is because some people may find it gentler on the digestive system than alendronate.

Risedronate can also be used as a second drug treatment. For example, you might swap risedronate if you're having problems with your first treatment, or if you've been on your first drug for several years and your doctor has recommended a change.

Who should not have risedronate?

Risedronate may not be suitable if you:

• can't swallow tablets

• have a problem with your oesophagus (gullet or food pipe), such as Barrett's oesophagus

• can't stand or sit up for at least half an hour (see below)

• have severe kidney problems

• have a low blood calcium level (hypocalcaemia) - you'll need to increase your intake of calcium and vitamin D before you can start risedronate

• are pregnant or breast-feeding.

Risedronate is available as either:

• 1 tablet (5mg) every day

• 1 tablet (35mg) every week.

The following steps are important for ensuring the treatment works properly. They will also help to make side effects less likely (see below).

Daily tablets

Follow the instructions above. But if you're on a daily dose and can't take your tablet in the morning, you can take it later in the day. This is only if you don't eat or drink anything (other than plain tap water) for two hours before or after taking the tablet.

Weekly tablets

Make sure you take your tablets regularly and correctly, on the same day each week. You may want to make a note in your diary or set a reminder on your phone, to help you remember.

Take your tablet as soon as you wake in the morning

It's very important to take risedronate on an empty stomach, as soon as you wake up. Swallow the tablet whole, with a glass of plain tap water. It's important not to crush, chew or suck it.

Then wait at least 30 minutes before having your first food or drink of the day (other than plain tap water). This is to make sure your body can absorb and use the drug.

If you forget to take your weekly tablet, wait until the next morning before taking it. Then return to your usual day the following week.

Don't take other medications or supplements during this time

If you take calcium supplements, wait at least half an hour after taking risedronate. This is because calcium can affect how well the drug is absorbed. Some doctors suggest waiting up to four hours, to leave even more time for the drug to be absorbed.

Stay upright for at least 30 minutes afterwards

You must not lie down for at least half an hour after taking your tablet. This helps the tablet go down quickly into the stomach where it is absorbed. Your food pipe is more likely to become irritated if you lie down straightaway.

As with any drug, risedronate can sometimes cause side effects. The most common side effects are listed below, along with some rare problems that might very occasionally happen after several years of treatment.

It is important to remember that in general, side effects are less common than many people think. Most people on risedronate don't have any problems. Even if you do get side effects at first, they usually improve quickly and there are ways to manage them.

For a full list of possible side effects, look at the patient information leaflet that comes with your treatment. If you don't have a copy, ask your doctor or pharmacist for one.

It's important to understand that many of these problems aren't actually caused by the drug. When a medicine is first tested, the people taking it have to report anything unusual to the researchers. The problems they report are often just as common in people who aren't taking the drug.

The following table has information on the main side effects and how common they are. For example, fewer than 1 person in every 10 people who take risedronate will get problems with their oesophagus (food pipe) or heartburn. The other 9 in every 10 people who use the drug will not have this problem.

Rare health risks:

If you do get any side effects that don't go away, it may help to:

• make sure the problem isn't caused by any other medication you are taking

• tell your doctor or pharmacist, who may be able to help find out what is causing the problem

• ask your doctor or pharmacist about other treatments that may suit you better.

When you start on risedronate, you may have an appointment after around three months, and again after one year. This is to check you're taking your treatment properly and not having any problems. Tell the doctor, nurse or pharmacist if you have any side effects (see below). They may be able to suggest ways to help manage them.

If you break a bone while taking risedronate, speak to your GP. Breaking a bone doesn't necessarily mean your treatment isn't working. But it may be a good idea to have a bone health assessment.

After about five years on risedronate, you should have a formal treatment review. Ask your doctor when this should happen if you're unsure.

At this review, your doctor will check if you still need a drug treatment, and that risedronate is still the right treatment for you.

You may have a bone density scan as part of your review, which will give your doctor some information about your bone strength. But they will need to consider other things as well, such as whether you've broken any bones since starting on risedronate.

While there's no clear way to prove for certain that your treatment is working, research has shown that osteoporosis drug treatments like risedronate are effective at lowering the risk of broken bones.

Following your review, your doctor may advise you to:

• stay on risedronate for another five years

• stop treatment for a year or two, if this is safe for you - this is known as a treatment pause

• start a different drug treatment instead of risedronate

• stop having any treatment.

Risedronate is a long-lasting treatment and should keep helping your bones for about 1-2 years after you stop taking it. Your doctor can advise you on what's best for you, based on your own situation.

As with any treatment, there are advantages and disadvantages to using risedronate. You should think about these when deciding whether to have risedronate, and about what's important to you. Here are some of the main things to consider.

Advantages

• It can help to reduce your risk of broken bones.

• It's available as a daily or weekly tablet.

• It starts to work quickly and is effective for at least five years of use.

• It keeps helping your bone strength for a while, even after you stop taking it.

Disadvantages

• As with all medications, some people get side effects.

• There are some possible health risks after several years of use, but these are rare.

• Tablets won't be suitable for everyone.

If you still feel unsure about starting or changing your medicine, see our information on finding the right osteoporosis treatment.

You can also try our free medicine support service, BoneMed Online (theros.org.uk/bonemed), which can help you to feel more confident about your treatment.